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Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
Copyright © 2019 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Patients need to meet only one of these criteria to be advised to undergo parathyroidectomy. They do not need to meet more than one these criteria.
BMD, bone mineral density; DXA, dual energy X-ray absorptiometry; CT, computed tomography; MRI, magnetic resonance imaging; VFA, vertebral fracture assessment.
aThe use of Z-scores instead of T-scores is recommended in evaluating BMD in premenopausal women and men younger than 50 years; bMost clinicians will first obtain a 24-hour urine for calcium excretion. If marked hypercalciuria is present (400 mg/day [10 mmol/day]), evidence of calcium-containing stone risk should be sought by a urinary biochemical stone risk profile. The presence of abnormal findings indicating increased calcium-containing stone risk and marked hypercalciuria is a guideline for parathyroidectomy.
Measurement | |
---|---|
Serum calcium (>upper limit of normal) | 1.0 mg/dL (0.25 mmol/L) |
Skeletal | A. BMD by DXA: T-score <–2.5 at lumbar spine, lumbar spine, total hip, femoral neck or distal 1/3 radiusa |
B. Vertebral fracture by X-ray, CT, MRI, or VFA | |
Renal | A. Creatinine clearance <60 cc/min |
B. 24-hour urine for calcium >400 mg/day (>10 mmol/day) and increased stone risk by biochemical stone risk analysisb | |
C. Presence of nephrolithiasis or nephrocalcinosis by X-ray, ultrasound, or CT | |
Age | <50 years |
Criterion | Protocol for operative success | PPV, % | NPV, % | Overall accuracy, % |
---|---|---|---|---|
Miami | A >50% ioPTH drop from the highest either pre-incision or pre-excision at 10 minutes after excision of all hyperfunctioning parathyroid gland(s) | 99.6 | 70.0 | 97.3 |
Vienna | A >50% ioPTH drop from the pre-incision value within 10 minutes after excision of all hyperfunctioning parathyroid gland(s) | 99.6 | 60.9 | 92.3 |
Rome | A >50% ioPTH drop from highest pre-excision level and/or ioPTH level within normal range at 20 minutes post-excision, and/or ≤7.5 ng/L less than the value at 10 minutes post-excision | 100 | 26.3 | 83.8 |
Halle | An ioPTH decay to <35 ng/L within 15 minutes after excision of all hyperfunctioning parathyroid gland(s) | 100 | 14.2 | 65 |
Patients need to meet only one of these criteria to be advised to undergo parathyroidectomy. They do not need to meet more than one these criteria. BMD, bone mineral density; DXA, dual energy X-ray absorptiometry; CT, computed tomography; MRI, magnetic resonance imaging; VFA, vertebral fracture assessment. aThe use of Z-scores instead of T-scores is recommended in evaluating BMD in premenopausal women and men younger than 50 years; bMost clinicians will first obtain a 24-hour urine for calcium excretion. If marked hypercalciuria is present (400 mg/day [10 mmol/day]), evidence of calcium-containing stone risk should be sought by a urinary biochemical stone risk profile. The presence of abnormal findings indicating increased calcium-containing stone risk and marked hypercalciuria is a guideline for parathyroidectomy.
PTH, parathyroid hormone; PPV, positive predictive value; NPV, negative predictive value; ioPTH, intraoperative parathyroid hormone.